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    • Setup sponsor based contract management rules, such as validity and default rate/discount structures applicable.
    • Define visit/encounter or episodic insurance limit rules.
    • Define visit/insurance category based copay% (min/max), deductibles and limits.
    • Define exclusions, pre-authorization rules, and setup Fee for Service/DRG/Per Diem billing configurations.
    • Place orders from pending prescriptions, approved pre-authorization requests, multi-visit packages, or direct orders with appropriate user controls.
    • Define cash/credit-based billing rules with none, single or multiple (up to 2) sponsors
    • Define bill and claim statuses to recognize revenue for cash, track sponsor receivables, and inpatient patient revenue management.
    • Manage patient/sponsor write offs.
    • Automated insurance plan based co-pay/deductible/limit based rules to split amounts between copay and sponsor payable portion.
    • Observation and daycare per diem billing as per HAAD standards
    • DRG Billing as per DHA/HAAD Standards.
    • Diagnosis based case rate billing model support.
    • Prescription to pre-auth request flow.
    • Manual and online pre-authorization request creation, approval tracking, cancellation, and resubmissions.
    • Integration with Shafafiya/eClaimLink platforms as per HAAD/DHA standards.
    • Pre-Auth to Billing-Order Management.
    • Claim form documentation.
    • Medical coding and claims scrubbing by the encounter, E&M, ICD, CPT, LOINC, Dental, Drug, HCPCS, DRG, Per Diem codes with adherence to Waseel/DHS/DHA/HAAD standards.
    • Integration with Waseel/DHS/Shafafiya and eClaimLink platforms for claim submissions.
    • Coder claim review features to ensure tracking of changes and liaising of changes between the medical coder, clinician, and administrative staff.
    • Claim management, batch creation, denial management, resubmission batch management by correction, or internal complaint.
    • UAE Self Pay claim submissions for cash cases and medical tourists
    • Claim History Tracking.
    • Accumed Integration ready.
    • Use reports to track sponsor receivables, activity denials, resubmissions, and ageing analysis
    • Sponsor Receivables tracking against outstanding Remittances
    • HAAD/DHA Integration ready for online remittances.
    • Denial management, Batch/Claim resubmission flow.